Abstract:
BACKGROUND: Perinatal death is a devastating experience for the mother and of
concern in clinical practice. Regular perinatal audit may identify suboptimal
care related to perinatal deaths and thus appropriate measures for its reduction.
The aim of this study was to perform a qualitative perinatal audit of intrapartum
and early neonatal deaths and propose means of reducing the perinatal mortality
rate (PMR).
METHODS: From 1st August, 2007 to 31st December, 2007 we conducted an audit of
perinatal deaths (n = 133) with birth weight 1500 g or more at Muhimbili National
Hospital (MNH). The audit was done by three obstetricians, two external and one
internal auditors. Each auditor independently evaluated the cases narratives.
Suboptimal factors were identified in the antepartum, intrapartum and early
neonatal period and classified into three levels of delay (community,
infrastructure and health care). The contribution of each suboptimal factor to
adverse perinatal outcome was identified and the case graded according to
possible avoidability. Degree of agreement between auditors was assessed by the
kappa coefficient.
RESULTS: The PMR was 92 per 1000 total births. Suboptimal factors were identified
in 80% of audited cases and half of suboptimal factors were found to be the
likely cause of adverse perinatal outcome and were preventable. Poor foetal heart
monitoring during labour was indirectly associated with over 40% of perinatal
death. There was a poor to fair agreement between external and internal auditors.
CONCLUSION: There are significant areas of care that need improvement. Poor
monitoring during labour was a major cause of avoidable perinatal mortality. This
type of audit was a good starting point for quality assurance at MNH. Regular
perinatal audits to identify avoidable causes of perinatal deaths with feed back
to the staff may be a useful strategy to reduce perinatal mortality.
